This is a review paper intended to bring to focus the concept of effective service delivery as applicable alth sector and the seemly causes of low productivity in the context of our country, Nigeria vis its attendant publichealthimplication. The objective of this review work is to determine the livery could contribute to meeting the health care needs of the population or otherwise in our circumstance as a nation. The methodology applied were traditional review of published literatures concerning the subject and bringing to fore the ues to form basis for policy formulation as well as further empirical studies as much as possible. This paper takes a look at the most occurring factors and /or components of effective health services delivery, under three (3) broad components, namely; Health System Infrastructure component, Material and Equipment component and Human Resource component, then, bringing to fore the overbearing feasible causes of low productivity in the health sector in Nigeria, such as poor vices, high cost of services, unavailability of drugs/basic equipment, attitude of health care providers, poor working environment, poor remuneration and sitting of health facilities, by using performance in its various dimensions as the measurable tool in these perspectives. The publichealthimplication of low productivity in the health sector may mean that the spectrum of activities geared toward prevention and control of diseases and or health conditions of eving or promoting optimal health of the population. In conclusion, it is very necessary that components/factors of effective health services delivery are adequately harnessed in a synergistic approach to solving issues of low productivity at every facet of our development as a nation, state, local government and community.
Tuberculosis is a major health problem throughout the world causing large number of deaths both in humans and animals, more than that from any other single infectious disease. It is a highly successful intracellular pathogen that has developed strategies to survive even in the presence of high immune pressure. The usual site of entry into the human body is through the airways, beginning with the inhalation of infected droplets expelled from another infected individual through coughing. Although being caused by a quite simple microorganism, TB is a multifaceted disease with a spectrum of antimicrobial effector pathways at play during different stages of infection, ranging from early innate to late adaptive immune responses during acute and chronic infection. Even though both innate and adaptive immunity are coordinated to protect the body from this infection and disease development, Cell mediated adaptive immunity is the main one against MTB infection. Ethiopia ranks seventh in the list of 22 high burden countries. In camel it is chiefly caused by M. tuberculosis and M. bovis, even though a typical Mycobacterium species are occasionally responsible for the outbreak of the disease. Camel TB has worldwide distribution and present countries where camels are reared even if it is not well recognized and confirmed in many developing countries including Ethiopia. The disease is manifested the clinical signs of chronic weight loss or emaciation, weakness, dyspnea, cough and enlarged lymph node and lesions of caseous nodules in different organs. Camel TB has publichealthimplication particularly in pastoral area of Ethiopia, nomadic
Calabar is located in the Tropical rain forest climate region with marked wet and dry seasons. Temperature is high all year round with average daily temperature of 32 o c. The city experience nine months of rainfall with annual precipitation of about 588mm. Calabar has a large urban setting with few pockets of sub-urban or semi urban areas. It has a predominantly Christian population, majority of who are public servants, business men and artisans. Calabar is cosmopolitan in nature with education at all levels taking a prime place in the activities of the people. It has two government Universities, more than one hundred Secondary Schools and more than three hundred Crèches/Nursery/Primary Schools.
The rapidly evolving mobile phone technology raised public concern about the possibility of associate adverse health effects. The telecom sector is providing millions of jobs in the world but it is also giving cancer and other serious health problem to billions of people besides causing harm to birds, animals, plants etc. to the living world. It is not only fastest growing industry but it is also creating fastest growing health problems. Many people are increasingly concerned about the possible health effects due to frequent, long term use of cell phone and the radiation. As year after year immense numbers of users of mobile phones, even small adverse effects on health could have major publichealthimplication. Traffic accidents caused by using telephone during driving are another public challenge. Mobile phones are often prohibited in hospitals and on airplanes, as the radiofrequency signals may interfere with certain electro-medical devices and navigation systems. In addition to the context of Nepal, as six voice telecom operators, more than 30 ISPs, more than 320 FM stations, more than 35 Television channels and one AM radio are already in operation, it is already high time to explore the signal level and develop the guidelines to minimize the health hazard from the electromagnetic radiation of wireless communication.
Latrine use was also affected by the age of the latrine, with households 2.85 times more likely to use latrines constructed two or more years ago compared to recently constructed latrines. It may be that households having a latrine for a longer period of time were more accustomed to using them. Latrine use was significantly associated with latrines needing maintenance. This may be due to more frequently used latrines needing maintenance after a certain period of use compared to unused ones. Respondents who had heard information about latrines were more likely to use them compared to their counterparts. This may be related to the difference in the knowledge and awareness levels of the two groups regarding human waste management and human health.
The sample used in this study was the entire population of veterans who engaged with the national charity over a one year period and who had been assessed as experiencing mental health issues. The use of this homogenous sample increases the confidence in the generalisability of the findings reported. For example, there has been a focus on the experiences of Iraq and Afghanistan veterans  whilst research conducted within UK help-seekers demonstrated that veterans take significant periods of time to seek support and that the largest proportion of those seeking help each year are from earlier deployments such as to Northern Ireland or the Balkans conflict . The use of data collected by the UK Government allowed comparisons between the study sample and the wider English population. Given the complexity of deprivation, the IMD allowed us to be confident in capturing the complex and multi-faceted nature of deprivation .
We carried out gender-stratified analyses, bearing in mind that men are more involved in disaster recovery and rescue operations following any type of disaster, while women are more involved in receiving grieving family members [1,2]. Our literature review indicated significant gender differences in reported health outcomes among men and women [26,27]. American females reported higher levels of PTSD symptoms (than males) during the time period three months after the 9-11 disaster  and evidence suggests women demonstrate greater levels of depression and anxiety symptoms and lesser levels of alcohol abuse than men following disaster exposure . Among those who were exposed to the USAir 1994 disaster in Chicago, it was found that female gender was protective of immune cell dysfunction and high blood pressure . Women used more social support as a coping strategy than men which may have buffered the negative effects of disaster on immune and cardiovascular system functioning . There were no other significant gender differences noted in relation to physical health impacts [28,29].
In our study, shooting gallery attendance was independently linked to more needle sharing, providing further support for prior research that injecting at a shooting gallery is an important context for needle sharing [15,10]. Research has shown that injecting with someone else in comparison to injecting alone is linked to more opportunity for needle sharing [39,40]. Thus, a higher level of needle sharing at shooting galleries is possibly due to the fact that a PWID has more chance to find other PWID for needle sharing at such places. Another possibility could be the unavailability of sterile needles/syringes at shooting galleries. In Vietnam, shooting galleries for poor PWID, who constitute a significant part of the PWID population, are often located in public or semi-public places . In such open settings, many PWID is reluctant to carry needles/syringes, which may lead to an arrest on charges of engaging in illegal activities . The need for hurried injections in open settings also fosters the use of previously used needles/syringes [41,42]. This explanation fits observed results from our study and prior research that lack of access to sterile needles/syringes and a non-supportive environment for safe injection contribute to continued needle sharing [19,20,24,27]. In Vietnam, it is generally difficult to implement HIV prevention interventions in shooting galleries since PWID are highly mobile to avoid police campaigns. However, in some IBBS provinces, the research team did not experience problems recruiting PWID at shooting galleries, suggesting that it may still be possible to introduce interventions which include components such as needle exchange program and distribution of bleach for disinfecting needles/syringes in these settings.
Since our main interest in the assessment of the hazard of death, which is estimated using time-to-event models, the inclusion criteria in the study was the availability of time from diagnosis to time of death for reported MERS-CoV cases. The difference between these two points provides the time length of follow-up. Therefore, our end point is the time-to- event, where event here is defined as death among coronavirus patients. Moreover, we recorded information regarding gender, age, country in which the patient was diagnosed with MERS-CoV. We focused our investigation on the following risk The first risk factor (RF1) is whether the patient consumed dairy camel farm product. The second risk factor (RF2) is whether the patient visited any camel farm. The third risk factor (RF3) is whether the patient was employed in a health care setting. The fourth risk factor (RF4) is the presence of co-morbidities. The collected information was entered into an Excel sheet and analyzed using the computer program IBM-SPSSv.20.
The bacteria Yersinia pestis is the etiologic agent of plague, one of the most devastating diseases in the history of humanity. The zoonosis - transmitted by infected fleas - is severe and distributed among countries of Africa, the Americas, and Asia. Humans are highly susceptible to the disease, and maybe infected directly or indirectly. Plague may reappear after decades of silence - with epidemic potential - which can aggravate its publichealth impact in the various regions. Additionally, due to its easy transmission and dissemination, plague is included with anthrax, botulism, smallpox, tularemia, and viral hemorrhagic fevers (Ebola, Marburg, and Arena virus) in Group A of potential bioterrorism agents. This article presents the main clinical-epidemiological elements of the plague, emphasizing its etiology, transmission, pathogenesis, clinical aspects, diagnosis, treatment, prevention, and aspects relating to bioterrorism.
Population: Sick or injured people or healthy volunteers of all ages. Intervention/Risk factor: Inclusion of interventions provided by lay people (i.e. basic first responders, lay caregivers and/or community health workers). When the intervention is feasible to be performed by lay people but performed by a healthcare professional, the study is included in case no other evidence with laypeople is available (but considered as indirect evidence). Interventions that require special equipment or competences were excluded, as well as interventions that do not take place during the acute phase which can be considered as aftercare. For risk factors, we included modifiable, proximal risk factors with a potential immediate implication for practice that results in primary prevention at the household or community level and risk factors related to healthy persons. Risk factors that lead to interventions with already proven effectiveness were excluded. Furthermore, risk factors that do not precede the outcome and risk factors that are common sense were excluded.
Despite an increase in unconventional natural gas development (UNGD) across the country, the exposures to the chemicals utilized throughout the process and the potential health impacts remain poorly understood. Many chemicals utilized in drilling operations have yet to be thoroughly analyzed, due to a lack of Chemical Abstract Service numbers or other necessary information . About 37% of the chemicals that were able to be identified by Chemical Abstract Service numbers used in UNGD had the ability to affect the endocrine system . These endocrine disrupting chemicals are of concern, as exposure during key periods of development can impact normal development and result in a number of deleterious health effects. Fetal development is an especially sensitive time in which exposure to endocrine disruptors may result in permanent physiological changes that would not be seen in adults exposed to similar levels of chemicals . Most birth defects occur during the first three months of pregnancy, the time of organogenesis . The Center for Disease Control and Prevention (CDC) estimates that 3% of babies born in the U.S. each year are born with a birth defect and birth defects are the leading cause of infant mortality in the United States .
Our analysis followed the DUQUE conceptual model, with determinants linked to external pressures from governance of the health system (regulations, legal environment, systems such as certification, financial constraints and professional population, etc.), and pressures exerted by the hospital context. Thanks mainly to the use of qualitative literature, we complemented the DUQUE model  using individual determinants, and those associated with professional interactions. This latter category of determinants is rarely studied, yet observation on a daily basis indicates that it could play an important role. Although the Human Factors approach has not yet reached a sufficiently high level of maturity in the area of health care , an increasing amount of research is currently being undertaken into links between patient safety and psychosocial factors [30-32].
The impact of the ten years of existence of the National Coordinating Centre for Health Technology Assessment (NCCHTA) was evaluated by a research team , through applying interviews and analyzing documents. It was concluded that HTAs produced for the NICE had greater impact, in terms of application to decision-making in the British system, but that few studies had estimated returns in monetary values, in terms of cost- benefit analysis or estimates of cost reduction. The review studies cost 40,000 pounds on average and clinical trials started at one million pounds. A total of 133 projects were analyzed. The impact indicators applied were publication in peer-reviewed journals, qualification of personnel, funding for new projects, presentation of results to different audiences (both academic and in practice). Qualitative analysis indicated that the professional body at national level and the agencies were the biggest beneficiaries. Overall, the times taken to present results, the quality of the results and the closeness of links with decision-makers were impact factors.
RVF outbreaks have persistently occurred in a cyclical pattern in eastern African countries resulting in significant adverse socio economic impact on health and food security since its discovery in 1912. Vulnerable ecologies are not only risk prone for periodic outbreaks but serve as index foci for future outbreaks in non-endemic environments. Ecology probably exerts selection pressure on the primary and secondary vectors of RVF during outbreaks at a given locality and time. With the prediction lead period of 2-6 months for the 2006-2008 outbreaks, RVF induced human deaths were estimated at 230, 158, 144 and 51 in Sudan, Kenya, Tanzania and Somali respectively. Thus, the integral noticeable challenges in the existing inter- and intra-sectoral outbreak response and disease mitigation strategies demand more stringent, collaborative and effective measures to mitigate future RVF impacts. Considering the identified risk epidemiological factors as well as challenges experienced during the past RVF outbreaks, phased disease mitigation, and outbreak prevention strategies are proposed.
Emergency contraception (EC) has been in use for over 50 years, available across many countries and contexts in multiple formulations and offered through various access points . Even though, the wide range of effective contraceptive options are available, women’s awareness and use of these options especially in developing countries is still lagging. Barriers to access and low patient and provider awareness limit the use of Emergency contraceptives in preventing unintended pregnancies [2- 4]. Consequently, unintended pregnancies continue to occur in large numbers worldwide. World Health Organization (WHO) estimated that 84 million unwanted pregnancies occur annually worldwide. About 3 million unwanted pregnancies occur in the United States. Most of these results are from nonuse of contraception or from noticeable contraceptive failure, (such as broken condom) which could be prevented with the use of Emergency contraceptives [5-7]. Despite the technological advancements in modern contraception methods, unintended pregnancy is still a big problem in Ethiopia. In Ethiopia, abortion emanating from unintended pregnancy is one of the most significant causes of maternal morbidity and mortality; it is also a major medical and publichealth problem. Ethiopia is one of the countries with high maternal mortality rate; the estimated rate in 2011 was 676 per100, 000 live births which is increased by three from 2005 Ethiopian democratic health survey report. Various reports show
Recently the healthcare system of China is faced with new challenges, such as the increased healthcare demands and expenditure, inefficient use of healthcare resources, unsatisfying implementation of disease management guidelines, and inadequate healthcare insurance , etc. Therefore, in 2009 the Chinese central government launched a landmark program to reform the healthcare system, which aimed at improving health care for all citizens by strengthening disease control and the primary care system. In China, public hospitals are the principal medical and health service institutions, and are essential for public welfare. Therefore, public hospital reform is an important factor for the realization of healthcare system reform in China. Former premier Wen Jiabao considered public hospital reform as one of the most important and challenging tasks in the new healthcare reform [2,3]. Doctors in public hospital are responsible for the implementation of the reform policies and the generation of support for the reform. Doctors are also the direct provider of hospital services and key element in the development of health services. The job satisfaction work performance and commitment of doctors directly influence medical safety, service quality, patient satisfaction, doctor–patient relationship, and particularly the operating efficiency and effectiveness of a hospital and hospital management . Several studies show that the job satisfaction of the doctor has a significant effect on the stability of the overall workforce and the quality of the health care delivered . Recent studies note that the job satisfaction and organizational commitment of employees are closely inter-related and correlated with turnover intention . It’s
While improvements in fetal surveillance and perinatal management have led to a reduction in diabetes related complications including perinatal mortality, the incidence of associated congenital anomalies remains high relative to the general population. Congenital heart defects occur in up to 8.5 per 100 live births of infants of diabetic mothers, and cardiac defects predominate [26, 27]. It was shown by Carrigan et al.  that fetal cardiac defects are associated with raised maternal glycosylated hemoglobin levels and are up to five times more likely in infants of mothers with pre-gestational diabetes compared with those without diabetes. Other studies emphasize the frequency with which the offspring of diabetes-complicated pregnancies suffer from complex forms of congenital heart disease . Earlier Towner et al.  found a correlation between oral hypoglycemic agents during early pregnancy and the increased risk of congenital malformations in infants of mothers with non-insulin-dependent diabetes mellitus (NIDDM), independent of maternal metabolic control. Schaefer et al.  estimated the prevalence of congenital anomalies in offspring of women with gestational and type 2 diabetes and found that there is no preferential increase in involvement of specific organ system and is similar to that previously described in pregnancies complicated by type 1 diabetes. In Saudi Arabia, data published by the Institute for health Metrics and Evaluation in 2013
Additionally, even when historical trauma is absent or more indirectly related, programs designed with cultural awareness will always be more relevant and influence the effectiveness of the intervention. As discussed above, an individual’s culture can affect their expectations for treatment, and programs that meet the patient’s expectations are more likely to be trusted and utilized. Further, taking into consideration culturally specific risk factors can improve outcomes, as exampled by the success of culturally adapted treatment and prevention of substance abuse among Latin American youth . Finally, culturally sensitive programs should utilize local practitioners and integrate community beliefs. Working with local providers builds trust, better meets the clients’ expectations, improves the long-term sustainability of the program, improves community independence, and helps restore pride and dignity [17, 19]. Many treatments offered through traditional medicine practitioners are available at a lower cost than conventional treatments, some of which, such as St. John’s wort, have been shown to have comparable efficacy to SSRIs in the treatment of depression . Practitioners of traditional and complementary medicine among lower income communities can help ameliorate the shortage of mental health providers in those communities. Although there are differences in etiologic understanding and implementation of treatments of mental health disorders between conventional western, traditional and complementary practitioners, collaboration across disciplines can appropriately provide effective and adequate care while balancing issues of access . One major problem with community and culturally based interventions, however, is that many currently lack empirical evidence supporting their utility and effectiveness, leading researchers and providers to fall back on more main- stream, “West-is-best” methods  which is why there has been a recent surge of support for community-based participatory research (CBPR). CBPR, designed specifically in response to health disparities, “focuses on relationships between academic and community partners, with principles of co-learning, mutual benefit, and long-term commitment